Policy offers recommendations for care of LGBTQ youth
- Copyright © 2013 by the American Academy of Pediatrics
A new AAP policy statement offers a wide range of suggestions for how pediatricians can better serve lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth.
The first AAP policy statement on this population since 2004 urges pediatricians to create teen-friendly offices that are welcoming to sexual minority youth, strive to obtain a comprehensive psychosocial and sexual history and, perhaps most importantly, work to avoid biased language that implies that all patients are heterosexual.
The statement from the AAP Committee on Adolescence also offers suggestions for communicating better with parents and identifying local resources for self-education and for helping patients.
The policy statement and accompanying technical report, both titled, Office-Based Care for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth (http://pediatrics.aappublications.org/cgi/doi/10.1542/peds.2013-1282), are published in the July issue of Pediatrics ( Pediatrics 2013;132:198-203OpenUrl).
The term “questioning” is used in the policy statement and technical report to refer to anyone struggling with sexual attractions and identity formation. “Sexual minority” includes LGBTQ and those who do not self-identify as LGBTQ but explore same-gender sexual behaviors.
Normal, just different
LGBTQ teens usually are resilient and often emerge from adolescence as healthy adults, the policy states. However, homophobia and heterosexism can contribute to health disparities. LGBTQ youth have higher rates of depression, substance abuse and sexually transmitted diseases. Sexual minority youth also are more likely to be sexually active than heterosexuals, increasing their risk for sexually transmitted infections (STIs).
The theme of the policy statement, said lead author David A. Levine, M.D., FAAP, is that “this doesn’t pathologize sexual minority youth.”
“These are children that are normal; they are just different,” he said.
While LGBTQ youth are different, Dr. Levine said that doesn’t mean they have health or psychosocial problems. At the same time, pediatricians need to be aware of how circumstances that LGBTQ youth face in daily life may play a role in their patient’s health.
This population needs a pediatrician’s support, Dr. Levine said, and doctors can make an important contribution through their efforts.
“Sexual minority youth need honest answers and compassion in dealing with issues and questions around sexual orientation, identity and sexual behaviors,” according to the technical report.
Pediatricians also should note that many adolescents who self-report as lesbian or gay may have sex with members of the opposite sex, and thus behaviors do not equal identity.
Establishing trust with patients
The Academy issued its first statement on sexual minority teens in 1983, with revisions in 1993 and 2004. Since the last report, research in this area has exploded.
Stigmatization and parental rejection are common among sexual minority youth, and struggles with self-image and self-esteem put these teens at risk, studies show. When teens “come out,” there often are significant repercussions and victimization. Two recent studies show 84% of open LGBTQ teens reported verbal harassment, 30% were physically assaulted and 28% dropped out of school.
Doctors can establish a good relationship with LGBTQ patients by using gender-neutral language when discussing sexual history, partners, friends or relationships. For example, pediatricians should ask a teenage girl, “Are you having sex?” instead of, “Are you and your boyfriend having sex?” Dr. Levine suggests the phrasing, “Tell me about your partner,” instead of using the term boyfriend or girlfriend.
The use of neutral language will help pediatricians establish trust with LGBTQ youth. With communication lines open, pediatricians then should work to ascertain a teen’s major risk behaviors and psychosocial concerns. For teens who are sexually active, and especially for those with multiple partners, STI testing should occur and contraception use should be emphasized.
Facilitating discussions with parents
Pediatricians also should attempt to break down barriers between LGBTQ youth and their parents, while maintaining the patient’s confidentiality about sexual matters. Often, a doctor can help facilitate difficult conversations between parents and LGBTQ youth, shielding teens from possible angry reactions.
The role of the pediatrician, Dr. Levine stressed, is not to “out” an adolescent to their family, but to help with discussions.
The policy statement also addresses health disparities for transgender youth, and urges pediatricians to encourage patients to discuss their sexual identities, feelings and concerns. Transgender teens need support and affirmation, the policy states, and doctors can provide education and referrals for transition.
Pediatricians also should support gay-straight alliances at schools and advocate for the development and enforcement of zero-tolerance policies for homophobic harassment.
The technical report (Pediatrics. Pediatrics 2013;132:e297-e313OpenUrl; http://pediatrics.aappublications.org/cgi/doi/10.1542/peds.2013-1283) provides a list of LGBTQ support and advocacy organizations that practitioners can use as resources, including information from the Gay and Lesbian Medical Association, www.glma.org.
For information on the new AAP Provisional Section on LGBT Health and Wellness, email staff manager Anne Gramiak, M.P.H., at.